Uncontrollable BG levels

[Annb]

I have been diagnosed T2 for about 12 years now, but possibly have had the condition for 50+ years (undiagnosed, obviously). At first I was put onto 4 x 500 mg Metformin but soon developed gastric issues and was taken in to hospital for investigation. When having these investigations, I couldn't take Metformin so "temporarily" I was put onto an insulin pump. I never came off insulin again, although I was told that I would. I thought they knew what they were talking about, but now I'm not at all sure about that. Anyway, just as well they checked because they found the early stages of bowel cancer and dealt with that. But the surgeon was of the opinion that the issue was Metformin, not the cancer.

My choice was 1 - stop taking Metformin and let the diabetes rip or 2 - keep taking the Metformin and put up with permanent diahorrea. I stopped the Metformin, but the BGs were ridiculous, despite the insulin. So I was put back on 2 x 500 mg of Metformin. Still the bowel issues. Plus, I was putting weight on fast.

I found out about low carbing and decided it would be a good way to go and have been doing this for 2 years now. At the beginning, I lost weight, and my BG started to come down. But now I'm not losing weight and I am not getting my BG under control. In fact, I am gaining weight. Carb intake is less than 20 g daily, most days. Since I make all my own food, I'm not absolutely sure of the number of calories, but it's not much because I usually eat only once or twice a day. If it's twice it is one small meal and a snack.

I would say that, for me, low carbing is not working BUT if, for any reason I do eat even a small amount of carbs, my BG goes through the roof and takes ages to come back down. This is with a level of insulin that my diabetic nurse was horrified by. I now take high levels of insulin whatever I am eating and that keeps BG around the 10 -12 mark. I am, clearly, insulin resistant.

All this historic rigmarole is to ask the questions - has anyone else had this experience and could it just be that my system is now over-sensitive to carbs and is over reacting in an allergic kind of way?

 

[DCUKMod]

@Annb - I'm not an insulin user, so my experiences will be very different from yours.

In your shoes, however, I would try an experiment, so 2 weeks, then review the happenings. My experiment would to go carnivore for two week.

No veggies, no grains, no sauces, just meat, and I'd likely find myself focusing on the fattier meats and fish as they have are much more flavour.

Most people do still see a small increase in their blood sugars, eating a carni diet, so it's unlikely you, or anyone else would achieve any sort of totally flat line, but it could smooth out some of the peaks.

Of course, to do this, you would have to be confident in adjusting your insulin levels as required. If you are on a mixed insulin, it could be tricky to get the balance right.

I don't recall if you take a mixed insulin or basal and bolus. Apologies.

(p.s. - I would likely allow myself milk in tea and coffee, as I'm not keen on cream in drinks, but that would be my only non-carni item for that 2 weeks.)

 

[ianf0ster]

Hi Annb, Sorry to hear of your problems.
There are several things that seem rather strange. The main one is that you say that neither Low Carb nor what you say are high doses of Insulin are keeping your BG down.
Can you give the actual types and units of the insulin you take and the typical BG levels you are getting both before and after your Low Carb meals. That will enable people with experience of T2 with Insulin to say if your case is really so unusual.

I just wonder if your pancreas has nearly given up making insulin as well as you being insulin resistant.

Since you have been very active in this forum, you must be aware that Metformin doesn't affect your BG much apart from to reduce the morning glucose dump from your liver - so stopping the metformin should not make much difference.
Metformin is considered to be a very safe drug with a long history, however in May of this year ( 2020 ) the US FDA recommended that some makers of extended release metformin remove some of their tablets from the SU market because of concerns about the 'unacceptable' level of a probable carcinogen found in some extended release tablets.

 

[Brunneria]

Metformin is considered to be a very safe drug with a long history, however in May of this year ( 2020 ) the US FDA recommended that some makers of extended release metformin remove some of their tablets from the SU market because of concerns about the 'unacceptable' level of a probable carcinogen found in some extended release tablets.

Hi Ian,

I just need to point out that Ann is in Scotland, and therefore the withdrawal of a few batches of an American brand of Metformin will have zero relevance to her digestive issues, or her cancer several years ago.

Wouldn't want to send her into a blind panic with info that isn't at all relevant to her, would we?

 

[Annb]

@DCUKMod, @ianf0ster and @Brunneria, thanks all for your replies. In fact, a few months ago I did try only eating meat products for about 3 weeks, but it caused so many digestive problems that I had to stop - 3 weeks isn't much time to check on the BG or weight results.

Not sure if there is any point taking Metformin and only have my diabetic clinic's word for it that I should (they are a few years behind the times with their advice) but I don't think they are doing much harm - unless I eat carbs; then all the digestive problems come back. My Metformin dose has decreased from 2000 mg daily to 1000. There is definitely a connection between carbs, Metformin and digestive problems.

I take a basal and bolus regime of insulin. Night times I take 66 units of Lantus Solostar and each meal I take 40 units of Humilin S. I don't really know, any longer, if that is too much. The diabetic nurse I spoke to a few days ago seems to think so.

I don't know why I was ever started on insulin really - for the hospital stay, I understand, but after only a couple of days on it, at that time, I don't think it needed to be continued. In fact, I was assured that it wouldn't be. I think all of the problems I have now are caused by insulin, but without it my BG goes through the roof. I thought the diabetic "experts" were just that and knew what they were talking about. I didn't have the internet at the time to look things up for myself.

 

[Goonergal]

a few months ago I did try only eating meat products for about 3 weeks, but it caused so many digestive problems that I had to stop - 3 weeks isn't much time to check on the BG or weight results.

Were they purely meat or did that include fish/eggs? If those are more palatable for you and cause fewer digestive issues, then trying a period of carb elimination may well be helpful in understanding what is going on.

 

[Brunneria]

It sounds to me as though you should be switched from fixed dose to carb counting and adjusting your dose accordingly.
Has that ever been suggested to you by your nurse or doc?
Obviously, your healthcare team would be a good resource to draw on to learn how to do this. You cannot be the only insulin user they have ever treated, so they must have some experience/knowledge to draw on to help you.

I mean, injecting a fixed amount for each meal, regardless of its carb content, when you are on a low carb way of eating, seems very odd. Perhaps you should rigorously count your carbs for a while, in case you are eating more than you think.

It would also enable you to work out your insulin to carb ratio. Which might help you to work out what is going on.

Another option could be fasting - if you read up on Jason Fung's blog Intensive Dietary management, he has excellent success with reducing T2 insulin resistance, and therefore their medications. But obviously that is something that would need careful insulin management during the fasting/dropping insulin resistant phase, and from the sound of things your healthcare team would struggle supporting you through that.

 

[Annb]

Were they purely meat or did that include fish/eggs? If those are more palatable for you and cause fewer digestive issues, then trying a period of carb elimination may well be helpful in understanding what is going on.

It was mostly meat with some eggs and fluids were water, tea and tea with whole milk. Fresh fish has been a problem here for quite a while so didn't include it in those 3 weeks. Meat doesn't seem to cause digestive issues as long as I have some veg as well.

 

[Annb]

It sounds to me as though you should be switched from fixed dose to carb counting and adjusting your dose accordingly.
Has that ever been suggested to you by your nurse or doc?
Obviously, your healthcare team would be a good resource to draw on to learn how to do this. You cannot be the only insulin user they have ever treated, so they must have some experience/knowledge to draw on to help you.

I mean, injecting a fixed amount for each meal, regardless of its carb content, when you are on a low carb way of eating, seems very odd. Perhaps you should rigorously count your carbs for a while, in case you are eating more than you think.

It would also enable you to work out your insulin to carb ratio. Which might help you to work out what is going on.

Another option could be fasting - if you read up on Jason Fung's blog Intensive Dietary management, he has excellent success with reducing T2 insulin resistance, and therefore their medications. But obviously that is something that would need careful insulin management during the fasting/dropping insulin resistant phase, and from the sound of things your healthcare team would struggle supporting you through that.

My healthcare team, so far, have been unwilling to countenance anything other than the rigid regime they have prescribed. It was my own decision to up the insulin to try to get some sort of control. It has actually been incredibly difficult to get hold of anyone in the department for some time - I did find someone in a few days ago and her answer was to keep it going for the present and see if a new basal insulin works better. I'll try to read up on Jason Fung and see what he has to say. Not sure my "team" will be much help, but never say never.

 

[Arab Horse]

I wonder if you have ever tried intermittent fasting. Not necessarily for whole dats to start with but just eating breakfast, and, if you need to, a loght lunch but leaving about 16 hours between lunch and breakfast. That works for me better than anything else. I would like to do a true fast of 24+ hours but as I was very under weight after my 2nd hop replacement I needed to put on some weight first as I was classed as "critically underweight" although I felt fine (but looked awful)!!!!

 

[Annb]

Yes, that was one of the things I tried last year. I know that a major part of my problem is that my joints are worn out so I am not able to do much in the way of exercise - just hobbling around the house is agonising. I am clearly taking in too much food for the amount of energy I am using. But I reduced the amount to what I thought was reasonable.

The first time I tried dieting - 50 years ago, a few months after I had my last son - I was counting calories and stayed rigidly around 900 calories a day. I did lose some weight, but I was eating all the wrong things and in about 2 months, I became quite ill. Gave up at that point. Just ate "normally" for the next 35 years and it rose again to 12 stone. I was doing plenty of exercise then but I was eating carbs as a major part of my diet. I was never tested for diabetes, despite having what I now know were obvious symptoms, until I asked a doctor if I could be. I was. Seems now that I may have had gestational diabetes which never went away.

Even so, until I went on insulin, I stayed at about 12 stone but in the last few years, whatever I do the weight has been piling on. On insulin, BG was not too bad (averaging about 9-10) for a year or so, but then it started to rise and, despite going low carb, trying intermittent fasting, having one meal a day when I can manage it but usually one meal and a smaller meal later, the insulin still doesn't control it. I am currently sitting around 11 - 15. I slipped a few days ago and had a breakfast roll - BG went up to 18.3 and stayed thereabouts for 2 days.

This morning I had 2 rashers of streaky bacon, oven crisped and 2 fried eggs. That will be my main meal today. Carbs in the bacon were zero, eggs were about 1 gram. Calories were about 260. About 3 pm I will be having stewed beef and kidney (snack sized dish)stuffed into some butternut squash. Haven't worked out the calories yet. BG currently 9.0 after 40 units of Humilin S and breakfast. Pretty good really.

 

[Deleted member 489048]

Trying and getting no where....... as is!!!!

 

[Annb]

Trying and getting no where....... as is!!!!

You and me both @WHT! Do you take insulin, or are you using other medication and/or diet to try to bring BG down?

 

[ziggy_w]

I have been diagnosed T2 for about 12 years now, but possibly have had the condition for 50+ years (undiagnosed, obviously). At first I was put onto 4 x 500 mg Metformin but soon developed gastric issues and was taken in to hospital for investigation. When having these investigations, I couldn't take Metformin so "temporarily" I was put onto an insulin pump. I never came off insulin again, although I was told that I would. I thought they knew what they were talking about, but now I'm not at all sure about that. Anyway, just as well they checked because they found the early stages of bowel cancer and dealt with that. But the surgeon was of the opinion that the issue was Metformin, not the cancer.

My choice was 1 - stop taking Metformin and let the diabetes rip or 2 - keep taking the Metformin and put up with permanent diahorrea. I stopped the Metformin, but the BGs were ridiculous, despite the insulin. So I was put back on 2 x 500 mg of Metformin. Still the bowel issues. Plus, I was putting weight on fast.

I found out about low carbing and decided it would be a good way to go and have been doing this for 2 years now. At the beginning, I lost weight, and my BG started to come down. But now I'm not losing weight and I am not getting my BG under control. In fact, I am gaining weight. Carb intake is less than 20 g daily, most days. Since I make all my own food, I'm not absolutely sure of the number of calories, but it's not much because I usually eat only once or twice a day. If it's twice it is one small meal and a snack.

I would say that, for me, low carbing is not working BUT if, for any reason I do eat even a small amount of carbs, my BG goes through the roof and takes ages to come back down. This is with a level of insulin that my diabetic nurse was horrified by. I now take high levels of insulin whatever I am eating and that keeps BG around the 10 -12 mark. I am, clearly, insulin resistant.

All this historic rigmarole is to ask the questions - has anyone else had this experience and could it just be that my system is now over-sensitive to carbs and is over reacting in an allergic kind of way?

Hi AnnB,

First of all, I'd like to give you a big hug. Cant imagine how frustrating this must be -- especially as it certainly appears as if you are doing all the right things.

This is just a bit of a thought experiment -- and to be honest I'm a bit reluctant to go there because I might be entirely wrong in my thinking.

Wonder if the root cause of your problem might be due to a very high level of insulin resistance-- probably not helped along by having to inject so much insulin. So, this might then cause quite a vicious cycle -- high blood sugars, followed by injecting highish levels of insulin, leading to hyperinsulinemia, leading to insulin resistance, leading to injected insulin being less effective, leading to highish blood sugars, and so on.

So, the first step might then actually be to find out how insulin resistant you are. Would your GP be willing to work with you on this?

The next step, if in fact insulin resistance is a major problem, might be thinking about how to break this cycle -- and a start might be to look at lowering insulin requirements. As others have suggested fasting might be a good option in this case (especially as going low low carb and intermittent fasting haven't seemed to make much of a difference, and more exercise obviously isn't an option). Also, carb counting and adjusting insulin correspondingly might help in this, as suggested by @Brunneria. Possibly also going just a bit lower protein (not too much though as we require sufficient protein intake) and higher fiber might reduce insulin requirements. I was also thinking of other ways to lower blood sugar without having to take more insulin. So, I wonder whether SLGT2s in your case might be an avenue to explore (though to be honest, I am generally not always a big fan because of some of the side effects).

This having been said, I might be entirely off-base in my thinking. Others may have much better insight and ideas.

Hope you find a way which will work for you.

 

[Annb]

Hi AnnB,

First of all, I'd like to give you a big hug. Cant imagine how frustrating this must be -- especially as it certainly appears as if you are doing all the right things.

This is just a bit of a thought experiment -- and to be honest I'm a bit reluctant to go there because I might be entirely wrong in my thinking.

Wonder if the root cause of your problem might be due to a very high level of insulin resistance-- probably not helped along by having to inject so much insulin. So, this might then cause quite a vicious cycle -- high blood sugars, followed by injecting highish levels of insulin, leading to hyperinsulinemia, leading to insulin resistance, leading to injected insulin being less effective, leading to highish blood sugars, and so on.

So, the first step might then actually be to find out how insulin resistant you are. Would your GP be willing to work with you on this?

The next step, if in fact insulin resistance is a major problem, might be thinking about how to break this cycle -- and a start might be to look at lowering insulin requirements. As others have suggested fasting might be a good option in this case (especially as going low low carb and intermittent fasting haven't seemed to make much of a difference, and more exercise obviously isn't an option). Also, carb counting and adjusting insulin correspondingly might help in this, as suggested by @Brunneria. Possibly also going just a bit lower protein (not too much though as we require sufficient protein intake) and higher fiber might reduce insulin requirements. I was also thinking of other ways to lower blood sugar without having to take more insulin. So, I wonder whether SLGT2s in your case might be an avenue to explore (though to be honest, I am generally not always a big fan because of some of the side effects).

This having been said, I might be entirely off-base in my thinking. Others may have much better insight and ideas.

Hope you find a way which will work for you.

Thanks for that reply @ziggy w, I will ask the diabetic nurse about SGLT2 inhibitors and see if she knows anything about it. The best I've had from any of the healthcare team so far is "You're probably insulin resistant," in a sort of "it's just fate, nothing to be done about it" kind of way. But that's what I was told when I was diagnosed with a fatty liver some years ago and I know now that that was just not true - not that I've had any success getting rid of the fat, but at least it's no worse than it was a few years back.

I think a lot of my problem is fluid retention. I take 2 lots of diuretic pills every day to try to get rid of some of it, but I still swell up during the day and reduce again at night. That's been happening for about 50 years as well.

I am thinking of increasing the amount of vegetables in my diet to increase fibre (and hope not to have too serious an effect on my bowel). If I load up with veg and just have a little meat, it should be OK. But I will have to watch it. More veg and less protein shouldn't mean too many carbs (not root veg, obviously) and should also help with the calorie levels I am aiming for (about 1000 daily).

I'll keep working on it.

 

[lucylocket61]

I have been successfully low carbing for over 8 years now. I eat lots of vegetables, eggs, cheese, not much red meat, sales. There are many ways to low carb.

 

[HSSS]

@Annb have they tested you c peptide to see just how much insulin you’re producing?

It could answer if you are highly resistant but still making plenty of your own in which case maybe the more drastic fasting option could break the cycle and alternatives to insulin might be considered or simply no longer producing your own in which case it’s never going take over the job of the exogenous insulin but obviously still need to address resistance issues but not by coming off insulin.

 

[Annb]

@Annb have they tested you c peptide to see just how much insulin you’re producing?

It could answer if you are highly resistant but still making plenty of your own in which case maybe the more drastic fasting option could break the cycle and alternatives to insulin might be considered or simply no longer producing your own in which case it’s never going take over the job of the exogenous insulin but obviously still need to address resistance issues but not by coming off insulin.

I did get a doctor to do a c-peptide test a few months ago. He had no idea what it was and I had to explain it to him. Turns out I am producing insulin. Don't know how much - I wasn't privy to that information. I have tried fasting on just water (I reduced fluids as well at one stage, because I have a problem with excess fluid making me swell up, and ended up in hospital). Oddly enough, my BG stayed high for most of the day when I did that, before dropping like a stone in the early evening. Then had to have some food - not much but possibly not the right thing (oatcakes) to put brakes on the drop. Then up it would go again. 2 oatcakes, with no insulin gives a rise of 21/2 - 3, so something like 2.8 to 4.8 or 5.

Edit: Sorry - the postman came (No 2 son) and I had to stop. I was about to say that this is why I am trying to do 18 hour fasts, but I still need fluids.

 

[ziggy_w]

Thanks for that reply @ziggy w, I will ask the diabetic nurse about SGLT2 inhibitors and see if she knows anything about it. The best I've had from any of the healthcare team so far is "You're probably insulin resistant," in a sort of "it's just fate, nothing to be done about it" kind of way. But that's what I was told when I was diagnosed with a fatty liver some years ago and I know now that that was just not true - not that I've had any success getting rid of the fat, but at least it's no worse than it was a few years back.

I think a lot of my problem is fluid retention. I take 2 lots of diuretic pills every day to try to get rid of some of it, but I still swell up during the day and reduce again at night. That's been happening for about 50 years as well.

I am thinking of increasing the amount of vegetables in my diet to increase fibre (and hope not to have too serious an effect on my bowel). If I load up with veg and just have a little meat, it should be OK. But I will have to watch it. More veg and less protein shouldn't mean too many carbs (not root veg, obviously) and should also help with the calorie levels I am aiming for (about 1000 daily).

I'll keep working on it.

Hi @Annb,

Thank you so much for your reponse. What a warrior you are. You definitely have my respect and admiration.

As to increasing fibers, if you are worried about digestive issues, it might be easier to up them gradually to see how it goes.

Personally, for me a diet high in protein is probably not optimal because on the one it slightly elevates my blood sugar levels and on the other hand, it makes me feel a bit constipated (though both these effects might be highly individual). So, I definitely do better with a bit of fiber (especially cauliflower, eggplant, zucchini, mushrooms, lettuce, avocado), which are quite low carb and might not be quite as tough on the digestive system.

However, as we often say on this forum, we are all different and what works for some might not work for others. So, there's probably some experimentation involved to figure out what works for you.

As to SGLT2s, the way they work is to actually make you pee out some of the glucose in your system. This ideally might lower your insulin requirements and with less circulating insulin, this might also eventually lower insulin resistance. Side effects, however, can include thrush, which is definitely no fun. Another potential side effect can be euglycemic ketoacidosis (i.e. ketoacidosis with close to normal blood sugar levels), which is quite rare though and probably shouldn't happen unless insulin levels are also quite low, but good to keep an eye out for.

Anyway, it might be worthwile discussing with your GP/nurse and weighing potential benefits against the drawbacks.

Keeping my fingers crossed that some of the helpful suggestions on the thread will work for you.

 

[Annb]

Hi @Annb,

Thank you so much for your reponse. What a warrior you are. You definitely have my respect and admiration.

As to increasing fibers, if you are worried about digestive issues, it might be easier to up them gradually to see how it goes.

Personally, for me a diet high in protein is probably not optimal because on the one it slightly elevates my blood sugar levels and on the other hand, it makes me feel a bit constipated (though both these effects might be highly individual). So, I definitely do better with a bit of fiber (especially cauliflower, eggplant, zucchini, mushrooms, lettuce, avocado), which are quite low carb and might not be quite as tough on the digestive system.

However, as we often say on this forum, we are all different and what works for some might not work for others. So, there's probably some experimentation involved to figure out what works for you.

Didn't do very well this morning - had a small amount of frozen cranachan (made with berries, coconut and mixed nuts with some double cream. Too fat rich and calorific. So shortly, I will be having a small portion of squash with a tablespoon of steak and kidney. That will be all until tomorrow morning, with an 18 hour break.

As to SGLT2s, the way they work is to actually make you pee out some of the glucose in your system. This ideally might lower your insulin requirements and with less circulating insulin, this might also eventually lower insulin resistance. Side effects, however, can include thrush, which is definitely no fun. Another potential side effect can be euglycemic ketoacidosis (i.e. ketoacidosis with close to normal blood sugar levels), which is quite rare though and probably shouldn't happen unless insulin levels are also quite low, but good to keep an eye out for.

Anyway, it might be worthwile discussing with your GP/nurse and weighing potential benefits against the drawbacks.

Keeping my fingers crossed that some of the helpful suggestions on the thread will work for you.

I think I said earlier that I did try only animal proteins for 3 weeks but it had a bad effect on my digestive system and I had to stop. I do think I may, still, be eating too much animal protein and am upping my veg levels while cutting down on meat products. All of the veg you mention are fine for me, except cauliflower, which has a disastrous effect on my system. I also eat squash, celeriac and broccoli, in varying amounts, without too much problem. Peppers, tomatoes and berries, I can also eat once in a while. I have pickled some cabbage and started off fermenting some cabbage and will see how that affects me. I have quite a lot of meat in the freezer and will have to make sure not to eat too much of a portion at a time.